The American Heart Association (AHA) reported in 2018 that there are more than 356,000 out-of-hospital cardiac arrests annually in the United States, nearly 90 percent of which are fatal. Death can result within minutes from cardiac arrest if proper steps—such as performing cardiopulmonary resuscitation (CPR) and using an automated external defibrillator (AED)—to shock the heart and restore a normal heart rhythm are not taken immediately. Trained non-medical personnel can used AEDs, which are simplified and portable electronic medical devices, to treat a person in cardiac arrest using voice prompts, lights and text messages to walk the responder through the steps. An analysis from the National Institutes of Health estimates that 18,000 Americans have shockable cardiac arrest out of hospitals and in public with witnesses. They estimate that 1,700 lives are saved each year by bystanders using an AED rather than waiting for emergency medical services to shock the heart.
Sudden cardiac arrest occurs when the heart fibrillates, or experiences chaotic and abnormal electrical activity that causes the heart to quiver uncontrollably. This is distinct from a heart attack, which occurs when the blood supply to part of the heart muscle itself is severely reduced or stopped because of an obstruction, although the two conditions are linked. Unlike a heart attack, cardiac arrest causes the heart to stop beating unexpectedly and a person has only minutes to live without treatment. AEDs can increase survival rates. According to the AHA, 9 in 10 cardiac arrest victims who receive a shock from an AED within the first minute live.
State Action on AEDs
Florida was the first state to enact a broad public access law in 1997 and as of 2010, all 50 states have since enacted defibrillator use laws or adopted regulations. Many states have considered how to encourage broader availability of AEDs, including provisions to encourage or require training on the use of AEDs, require that maintenance and testing meet manufacturers’ standards, create a registry of defibrillator locations, establish a “Good Samaritan” exemption from liability, and authorize state agencies to determine more detailed requirements for training and registration. Advocates have encouraged placements of AEDs in public buildings, transportation centers and large offices or apartment buildings.
Several states have proposed or adopted legislation requiring the placement of AEDs in health clubs and gyms, school athletic events or settings, and other public spaces. The 50-state AED list below links to third-party resources (AED Brands and AED Universe) that track AED laws in each state. The state profiles include summaries of requirements for use, Good Samaritan protection, and a list of laws and legislation. Please note that NCSL does not endorse the content of third-party resources.
Alabama | Alaska | Arizona | Arkansas | California | Colorado | Connecticut | Delaware | District of Columbia | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | Maine | Maryland | Massachusetts | Michigan | Minnesota | Mississippi | Missouri | Montana | Nebraska | Nevada | New Hampshire | New Jersey | New Mexico | New York | North Carolina | North Dakota | Ohio | Oklahoma | Oregon | Pennsylvania | Rhode Island | South Carolina | South Dakota | Tennessee | Texas | Utah | Vermont | Virginia | Washington | West Virginia | Wisconsin | Wyoming
Federal Action on AEDs
The Aviation Medical Assistance Act was signed into law in 1998 by President Clinton as the first federal law addressing AEDs. It directed the Federal Aviation Administration to evaluate regulations and decide on future authorized use of AEDs on passenger aircraft and in airports. In 2000, President Clinton signed the federal Cardiac Arrest Survival Act, regarding the placement of AEDs in federal buildings and providing civil immunity for authorized users. The Act appropriated $25 million in local grants to purchase AEDs. Many existing state laws on AED placement and use cover additional issues not addressed by the Cardiac Arrest Survival Act.
In 2002, President Bush signed the Community Access to Emergency Devices Act into law, authorizing $30 million in federal grants to be made available to applying states and localities. Grant funds were used for the purchase and placement of AEDs in public places and to train first responders in administering life-saving care, including on AED usage and cardiopulmonary resuscitation. The U.S. Food and Drug Administration issued several regulations on AEDs, including required premarket approval for new and existing AEDs (2015) and necessary accessories (2020) after reports of failing or malfunctioning devices. Some issues were due to manufacturing problems, while others were due to improper maintenance such as battery failure.
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State Legislative History: 1997-2016
Florida was the first state to enact such a broad public access law in April 1997 (Chapter 34 of 1997).
In 2003, Utah updated its AED law by establishing a statewide registry; while Virginia updated AED laws by deleting the requirement for registration. Alabama, Alaska, Colorado, Connecticut, Indiana, Kansas, Nebraska, Nevada, Tennessee and Texas also changed or expanded their AED laws.
In 2004, AED laws were changed or expanded in Connecticut, Florida, Hawaii, Idaho, Illinois, Louisiana, Maine, Michigan, Missouri, New York, Ohio, Oklahoma and Rhode Island. The Illinois law (H. 4232) requires every physical fitness facility to have at least one AED on premises, by mid-July 2006, with exceptions.
In 2005-06, Maryland added a requirement that every high school and school-sponsored athletic events have an AED available. California required health clubs to have at least one AED. Florida authorized state and local police vehicles to carry an AED. Indiana and Virginia repealed filing and training requirements. New York required places of public assembly to maintain an AED. Oregon updated Good Samaritan protection for trained AED providers, employers, property-owners and sponsoring agencies. Arizona, Colorado, Florida, Illinois, Maryland, Massachusetts, Nebraska, New Jersey, Pennsylvania, and Wisconsin also enacted AED laws.
In 2007, Texas added a requirement for AEDs not approved for over-the-counter sales.
In 2008 laws were enacted in Georgia, Idaho, Illinois, Indiana, Iowa, Massachusetts, New Hampshire, New York, South Carolina, Tennessee, West Virginia, Wisconsin and the District of Columbia (as of July 8, 2008).
In 2009, Illinois added dentist offices; Kansas and North Carolina expanded access by allowing "any person to use an AED”.
In 2010, Arizona, Idaho, Maryland, Missouri and Oregon enacted laws to assure that program facilitators, individuals, businesses and entities that place AEDs in their establishments are afforded appropriate immunity. Maryland and Missouri’s new laws also guarantee protections to lay rescuers who in “good faith” use an AED when working to save someone from sudden cardiac arrest. Iowa and Wisconsin require all high school students to be offered life-saving CPR training. These trainings must offer psychomotor skill development, which help ensure critical hands-on course work will be offered. Arkansas secured $300,000 to fund a Medical Emergency Response Planning in Schools program to assure that the AEDs are placed appropriately, and school staff is trained properly. (adopted from AHA materials).
From 2011-12, state legislation related to a variety of subjects: training in the workplace, schools, and medical facilities, availability of Defibrillators (AEDs) in gyms, places of work, schools, government buildings, community centers, golf courses, public areas, and medical facilities, a declaration of Cardiac Awareness Month, emergency actions plans of school districts to include Defibrillators (AEDs) in their emergency plan equipment, immunity from civil liability for the use of Defibrillators (AEDs) in good faith during an emergency, and tax credits for the cost of purchasing Defibrillators (AEDs).
From 2015-16, several states considered legislation aimed specifically at primary and secondary school athletic activities, including games off school property.